Multi-organ point-of-care ultrasound for COVID-19 (PoCUS4COVID): international expert consensus.

COVID-19 has caused great devastation in the past year. Multi-organ point-of-care ultrasound (PoCUS) including lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS) as a clinical adjunct has played a significant role in triaging, diagnosis and medical management of COVID-19 patients. The expert panel from 27 countries and 6 continents with considerable experience of direct application of PoCUS on COVID-19 patients presents evidence-based consensus using GRADE methodology for the quality of evidence and an expedited, modified-Delphi process for the strength of expert consensus. The use of ultrasound is suggested in many clinical situations related to respiratory, cardiovascular and thromboembolic aspects of COVID-19, comparing well with other imaging modalities. The limitations due to insufficient data are highlighted as opportunities for future research.post-print2.282 K

Situational judgement tests in medical education and training: Research, theory and practice: AMEE Guide No. 100

Why use SJTs? Traditionally, selection into medical education professions has focused primarily upon academic ability alone. This approach has been questioned more recently, as although academic attainment predicts performance early in training, research shows it has less predictive power for demonstrating competence in postgraduate clinical practice. Such evidence, coupled with an increasing focus on individuals working in healthcare roles displaying the core values of compassionate care, benevolence and respect, illustrates that individuals should be selected on attributes other than academic ability alone. Moreover, there are mounting calls to widen access to medicine, to ensure that selection methods do not unfairly disadvantage individuals from specific groups (e.g. regarding ethnicity or socio-economic status), so that the future workforce adequately represents society as a whole. These drivers necessitate a method of assessment that allows individuals to be selected on important non-academic attributes that are desirable in healthcare professionals, in a fair, reliable and valid way. [Table: see text] What are SJTs? Situational judgement tests (SJTs) are tests used to assess individuals' reactions to a number of hypothetical role-relevant scenarios, which reflect situations candidates are likely to encounter in the target role. These scenarios are based on a detailed analysis of the role and should be developed in collaboration with subject matter experts, in order to accurately assess the key attributes that are associated with competent performance. From a theoretical perspective, SJTs are believed to measure prosocial Implicit Trait Policies (ITPs), which are shaped by socialisation processes that teach the utility of expressing certain traits in different settings such as agreeable expressions (e.g. helping others in need), or disagreeable actions (e.g. advancing ones own interest at others, expense). Are SJTs reliable, valid and fair? Several studies, including good quality meta-analytic and longitudinal research, consistently show that SJTs used in many different occupational groups are reliable and valid. Although there is over 40 years of research evidence available on SJTs, it is only within the past 10 years that SJTs have been used for recruitment into medicine. Specifically, evidence consistently shows that SJTs used in medical selection have good reliability, and predict performance across a range of medical professions, including performance in general practice, in early years (foundation training as a junior doctor) and for medical school admissions. In addition, SJTs have been found to have significant added value (incremental validity) over and above other selection methods such as knowledge tests, measures of cognitive ability, personality tests and application forms. Regarding differential attainment, generally SJTs have been found to have lower adverse impact compared to other selection methods, such as cognitive ability tests. SJTs have the benefit of being appropriate both for use in selection where candidates are novices (i.e. have no prior role experience or knowledge such as in medical school admissions) as well as settings where candidates have substantial job knowledge and specific experience (as in postgraduate recruitment for more senior roles). An SJT specification (e.g. scenario content, response instructions and format) may differ depending on the level of job knowledge required. Research consistently shows that SJTs are usually found to be positively received by candidates compared to other selection tests such as cognitive ability and personality tests. Practically, SJTs are difficult to design effectively, and significant expertise is required to build a reliable and valid SJT. Once designed however, SJTs are cost efficient to administer to large numbers of candidates compared to other tests of non-academic attributes (e.g. personal statements, structured interviews), as they are standardised and can be computer-delivered and machine-marked

Fatty acid ethyl ester synthase inhibition ameliorates ethanol-induced Ca2+-dependent mitochondrial dysfunction and acute pancreatitis

Objective Non-oxidative metabolism of ethanol (NOME) produces fatty acid ethyl esters (FAEEs) via carboxylester lipase (CEL) and other enzyme action implicated in mitochondrial injury and acute pancreatitis (AP). This study investigated the relative importance of oxidative and non-oxidative pathways in mitochondrial dysfunction, pancreatic damage and development of alcoholic AP, and whether deleterious effects of NOME are preventable. Design Intracellular calcium ([Ca2+]C), NAD(P)H, mitochondrial membrane potential and activation of apoptotic and necrotic cell death pathways were examined in isolated pancreatic acinar cells in response to ethanol and/or palmitoleic acid (POA) in the presence or absence of 4-methylpyrazole (4-MP) to inhibit oxidative metabolism. A novel in vivo model of alcoholic AP induced by intraperitoneal administration of ethanol and POA was developed to assess the effects of manipulating alcohol metabolism. Results Inhibition of OME with 4-MP converted predominantly transient [Ca2+]C rises induced by low ethanol/POA combination to sustained elevations, with concurrent mitochondrial depolarisation, fall of NAD(P)H and cellular necrosis in vitro. All effects were prevented by 3-benzyl-6-chloro-2-pyrone (3-BCP), a CEL inhibitor. 3-BCP also significantly inhibited rises of pancreatic FAEE in vivo and ameliorated acute pancreatic damage and inflammation induced by administration of ethanol and POA to mice. Conclusions A combination of low ethanol and fatty acid that did not exert deleterious effects per se became toxic when oxidative metabolism was inhibited. The in vitro and in vivo damage was markedly inhibited by blockade of CEL, indicating the potential for development of specific therapy for treatment of alcoholic AP via inhibition of FAEE generation

The Type Ia Supernova Rate in Redshift 0.5--0.9 Galaxy Clusters

Supernova (SN) rates are potentially powerful diagnostics of metal enrichment and SN physics, particularly in galaxy clusters with their deep, metal-retaining potentials and relatively simple star-formation histories. We have carried out a survey for supernovae (SNe) in galaxy clusters, at a redshift range 0.5<z<0.9, using the Advanced Camera for Surveys (ACS) on the Hubble Space Telescope. We reimaged a sample of 15 clusters that were previously imaged by ACS, thus obtaining two to three epochs per cluster, in which we discovered five likely cluster SNe, six possible cluster SNe Ia, two hostless SN candidates, and several background and foreground events. Keck spectra of the host galaxies were obtained to establish cluster membership. We conducted detailed efficiency simulations, and measured the stellar luminosities of the clusters using Subaru images. We derive a cluster SN rate of 0.35 SNuB +0.17/-0.12 (statistical) \pm0.13 (classification) \pm0.01 (systematic) [where SNuB = SNe (100 yr 10^10 L_B_sun)^-1] and 0.112 SNuM +0.055/-0.039 (statistical) \pm0.042 (classification) \pm0.005 (systematic) [where SNuM = SNe (100 yr 10^10 M_sun)^-1]. As in previous measurements of cluster SN rates, the uncertainties are dominated by small-number statistics. The SN rate in this redshift bin is consistent with the SN rate in clusters at lower redshifts (to within the uncertainties), and shows that there is, at most, only a slight increase of cluster SN rate with increasing redshift. The low and fairly constant SN Ia rate out to z~1 implies that the bulk of the iron mass in clusters was already in place by z~1. The recently observed doubling of iron abundances in the intracluster medium between z=1 and 0, if real, is likely the result of redistribution of existing iron, rather than new production of iron.Comment: Accepted to ApJ. Full resolution version available at http://kicp.uchicago.edu/~kerens/HSTclusterSNe

The impact of iodine supplementation and bread fortification on urinary iodine concentrations in a mildly iodine deficient population of pregnant women in South Australia

Abstract Mild iodine deficiency during pregnancy can have significant effects on fetal development and future cognitive function. The purpose of this study was to characterise the iodine status of South Australian women during pregnancy and relate it to the use of iodine-containing multivitamins. The impact of fortification of bread with iodized salt was also assessed. Women (n = 196) were recruited prospectively at the beginning of pregnancy and urine collected at 12, 18, 30, 36 weeks gestation and 6 months postpartum. The use of a multivitamin supplement was recorded at each visit. Spot urinary iodine concentrations (UIC) were assessed. Median UICs were within the mildly deficient range in women not taking supplements (&lt;90 μg/L). Among the women taking iodine-containing multivitamins UICs were within WHO recommendations (150-249 μg/L) for sufficiency and showed an increasing trend through gestation. The fortification of bread with iodized salt increased the median UIC from 68 μg/L to 84 μg/L (p = .011) which was still in the deficient range. Pregnant women in this region of Australia were unlikely to reach recommended iodine levels without an iodine supplement, even after the mandatory iodine supplementation of bread was instituted in October 2009

Los procesos de socialización de docentes de inglés del Programa Nacional de Inglés para educación básica en las primarias públicas de Baja California

El presente estudio busca conocer los procesos de socialización del personal docente que labora en el Programa Nacional de Inglés a nivel primaria y preescolar en Ensenada Baja California, México, para identificar, por un lado, la construcción de la identidad docente desde un enfoque socio pedagógico y; por otro, dar cuenta del contexto en el cual se encuentra inmerso para así contribuir al diálogo en apoyo a acciones que mejoren su entorno. Nuestro propósito no es solo generalizar sobre la construcción de identidades, sino también profundizar sobre el proceso que experimentan docentes que trabajan en el programa. Para enmarcar esta información se realizó un estudio cualitativo con orientación a estudio de caso. Los datos fueron recolectados a través de entrevistas semiestructuradas a un grupo de sujetos clave utilizando el método de análisis por categorías para organizar y concretar los resultados. La intervención circunscribe dos tipos de docentes; aquel grupo que cuenta con una formación pedagógica base, producto de su paso por programas formales de instrucción a nivel de universidad y, otros grupos que obtuvieron su trabajo como docentes por el manejo del inglés o su pertenencia al sistema educativo. También es significativa la manifestación de una falta de inducción al programa para su ingreso al contexto escolar, la precariedad de las condiciones laborales, la falta de apoyo para la capacitación pedagógica y el poco reconocimiento de la imagen del personal docente de lenguas por la sociedad

Learning from errors:Assessing final year medical students' reflection on safety improvement, five year cohort study

Abstract Background Investigation of real incidents has been consistently identified by expert reviews and student surveys as a potentially valuable teaching resource for medical students. The aim of this study was to adapt a published method to measure resident doctors’ reflection on quality improvement and evaluate this as an assessment tool for medical students. Methods The design is a cohort study. Medical students were prepared with a tutorial in team based learning format and an online Managing Incident Review course. The reliability of the modified Mayo Evaluation of Reflection on Improvement tool (mMERIT) was analysed with Generalizability G-theory. Long term sustainability of assessment of incident review with mMERIT was tested over five consecutive years. Results A total of 824 students have completed an incident review using 167 incidents from NHS Tayside’s online reporting system. In order to address the academic practice gap students were supervised by Senior Charge Nurses or Consultants on the wards where the incidents had been reported. Inter-rater reliability was considered sufficiently high to have one assessor for each student report. There was no evidence of a gradient in student marks across the academic year. Marks were significantly higher for students who used Section Questions to structure their reports compared with those who did not. In Year 1 of the study 21 (14%) of 153 mMERIT reports were graded as concern. All 21 of these students achieved the required standard on resubmission. Rates of resubmission were lower (3% to 7%) in subsequent years. Conclusions We have shown that mMERIT has high reliability with one rater. mMERIT can be used by students as part of a suite of feedback to help supplement their self-assessment on their learning needs and develop insightful practice to drive their development of quality, safety and person centred professional practice. Incident review addresses the need for workplace based learning and use of real life examples of mistakes, which has been identified by previous studies of education about patient safety in medical schools

The Impact of Pandemic Management Strategies on Staff Mental Health, Work Behaviours, and Resident Care in One Long-Term Care Facility in British Columbia: A Mixed Method Study

Context: To slow the spread of COVID-19 within the Canadian long-term residential care (LTRC) sector, a series of pandemic management strategies were introduced, including restricted visitation and single site employment. These strategies were enacted to prevent and control infection, resulting in unknown impact on direct care staff and staff capacity to deliver quality care or service. Objective: To explore staff reports of outcomes associated with LTRC pandemic management strategies, particularly their impact on LTRC staff mental health, work behaviours and quality of care or service provision. Method: This was a case study using mixed methods including a longitudinal survey and interviews with staff from one LTRC site in British Columbia. Survey data from 68 staff who participated in both survey times were analyzed using regressions with relative weight analysis. Semi-structured interviews were conducted with 26 LTRC staff and analyzed using content analysis. Findings: Survey data demonstrated that staff perceived the sick time policy and staffing levels as the most inadequate pandemic management strategies. Survey data also showed the visitation policy, the sick time policy and the single site employment policy were most significantly associated with negative outcomes to staff mental health, work behaviours and quality of care or service delivery. Qualitative data suggested connections between these policies and inadequate staffing levels and heavy workloads. Limitations: The study design along with the low response rate and the small sample size limits the generalizability of the findings to other settings. Implications: The development and implementation of pandemic management strategies must be informed by and give consideration to working conditions of LTRC staff including long standing systemic issues such as staffing shortages and heavy workloads

The impact of iodine supplementation and bread fortification on urinary iodine concentrations in a mildly iodine deficient population of pregnant women in South Australia

Mild iodine deficiency during pregnancy can have significant effects on fetal development and future cognitive function. The purpose of this study was to characterise the iodine status of South Australian women during pregnancy and relate it to the use of iodine-containing multivitamins. The impact of fortification of bread with iodized salt was also assessed. Women (n = 196) were recruited prospectively at the beginning of pregnancy and urine collected at 12, 18, 30, 36 weeks gestation and 6 months postpartum. The use of a multivitamin supplement was recorded at each visit. Spot urinary iodine concentrations (UIC) were assessed. Median UICs were within the mildly deficient range in women not taking supplements (<90 μg/L). Among the women taking iodine-containing multivitamins UICs were within WHO recommendations (150–249 μg/L) for sufficiency and showed an increasing trend through gestation. The fortification of bread with iodized salt increased the median UIC from 68 μg/L to 84 μg/L (p = .011) which was still in the deficient range. Pregnant women in this region of Australia were unlikely to reach recommended iodine levels without an iodine supplement, even after the mandatory iodine supplementation of bread was instituted in October 2009.Vicki L Clifton, Nicolette A Hodyl, Paul A Fogarty, David J Torpy, Rachel Roberts, Ted Nettelbeck, Gary Ma and Basil Hetze

Monocyte chemoattractant protein-1 promotes macrophage-mediated tubular injury, but not glomerular injury, in nephrotoxic serum nephritis

Monocyte chemoattractant protein-1 (MCP-1) is upregulated in renal parenchymal cells during kidney disease. To investigate whether MCP-1 promotes tubular and/or glomerular injury, we induced nephrotoxic serum nephritis (NSN) in MCP-1 genetically deficient mice. Mice were analyzed when tubules and glomeruli were severely damaged in the MCP-1–intact strain (day 7). MCP-1 transcripts increased fivefold in MCP-1–intact mice. MCP-1 was predominantly localized within cortical tubules (90%), and most cortical tubules were damaged, whereas few glomerular cells expressed MCP-1 (10%). By comparison, there was a marked reduction (>40%) in tubular injury in MCP-1–deficient mice (histopathology, apoptosis). MCP-1–deficient mice were not protected from glomerular injury (histopathology, proteinuria, macrophage influx). Macrophage accumulation increased adjacent to tubules in MCP-1–intact mice compared with MCP-1–deficient mice (70%, P < 0.005), indicating that macrophages recruited by MCP-1 induce tubular epithelial cell (TEC) damage. Lipopolysaccharide-activated bone marrow macrophages released molecules that induced TEC death that was not dependent on MCP-1 expression by macrophages or TEC. In conclusion, MCP-1 is predominantly expressed by TEC and not glomeruli, promotes TEC and not glomerular damage, and increases activated macrophages adjacent to TEC that damage TEC during NSN. Therefore, we suggest that blockage of TEC MCP-1 expression is a therapeutic strategy for some forms of kidney disease.published_or_final_versio